DOJ Recoups $2.6 Billion from Home Health Fraud, Other Schemes in 2019

The 2019 fiscal year concluded with the Department of Justice (DOJ) bringing in $2.6 billion in recoveries involving health care fraud and false claims. Home health-related fraud was a large part of these efforts.  This marks the 10th consecutive year that the department’s civil health care fraud settlements and judgments have exceeded $2 billion. The […]

Home Health Owners Pay Price for $38 Million ‘Empire of Fraud’

Federal watchdogs have tied a bow on a key part of one of the largest Medicare fraud schemes in history. The U.S. Attorney’s Office for the Southern District of Florida announced Friday that Rodolfo Pichardo and Marta Pichardo — husband and wife — were each sentenced to several years in prison for their roles building […]

CMS Proposes New Rule Targeting Fiscal Integrity of Medicaid

In September, the owner and operator of an Atlanta-based in-home care provider pleaded guilty to defrauding Medicaid in a $1.2 million scheme. Shortly before that, a Boston-based in-home provider agreed to pay $1.95 million in a settlement to resolve allegations that it submitted Medicaid claims without physician authorization in August. These cases are both part […]

CMS Wants to Use Artifical Intelligence to Sniff Out Home Health Fraud

Federal watchdogs and health care policymakers are signaling plans to ramp up oversight of fraud, waste and abuse in 2020, especially when it comes to home health and hospice agencies. While the efforts are, in part, linked to the misuse of Medicare dollars by bad actors, they’re also simply a result of the U.S. health […]

Texas Physician Found Guilty of $16M Home Health Scheme; Pennsylvania Provider Accused of ‘Sham Staffing’

A Texas-based physician has been found guilty for taking part in a $16 million Medicare scheme. On Oct. 7, the U.S. Department of Justice (DOJ) announced that, after a six-day trial, Dr. Yolanda Hamilton was convicted of a single count of conspiracy to commit health care fraud and conspiracy to solicit and receive health care […]

What ‘Significant’ AseraCare Ruling Means for Home Health Providers

A recent hospice-related court ruling may impact how federal watchdogs and whistleblowers go after home health agencies moving forward. Last month, the U.S. Court of Appeals for the Eleventh Circuit issued its long-anticipated decision in United States vs. AseraCare, a winding legal battle involving false claims allegations dating back to 2008. Hospice companies, other Medicare-reimbursed […]

New York Home Care Agency Allegedly Threatened Workers with Deportation

A New York-based home care agency is being placed under the microscope for its treatment of immigrant workers. Allcare Homecare Agency Inc. allegedly threatened to report immigrant workers to Immigration and Customs Enforcement (ICE) agents when they complained about unpaid wages, according to a Friday statement from the New York State Attorney General’s Office.  As […]

Bay Area Home Health Provider Charged in $115M Medicare Scheme; Medicaid Fraud Defendants Plead Guilty

Home Health Provider Charged in Largest Ever Cash-for-Patient Scheme in NorCal The Bay Area’s largest home health care provider has been charged by federal prosecutors with paying doctors in a Medicare kickback scheme involving millions of dollars of payments in cash, Warriors tickets, designer handbags and more. Amity Home Health Care paid kickbacks to doctors, […]

[Updated] Guardian Healthcare Resolves Improper Billing Allegations; Home Health Recruiter Found Guilty in Medicaid Kickback Scheme

Guardian Healthcare resolves allegations Boston-based Guardian Healthcare has entered into a financial settlement with MassHealth, the Massachusetts Medicaid program, according to Law360.  The home-based care provider — which offers home health and home care services — agreed to pay $1.95 million to resolve allegations that it submitted Medicaid claims without physician authorization that the services were […]